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Liver Center | Referrals & Transfers

Physician Resources

Referrals
To refer a patient to the Hartford Hospital Comprehensive Liver Center complete the on-line referral form or call 860.972.4262.

Forms
The following forms are available for download (click here for more forms):

  • Ambulatory Record
  • Authorization to Disclose Health Information (HH) (English)
  • Authorization to Disclose Health Information (HH) (Spanish)
  • Consent for Radiation Therapy (English)
  • Consent for Radiation Therapy (Spanish)
  • Informed Consent (English)
  • Informed Consent (Spanish)
  • Informed Consent for Liver Transplant Evaluation Process (English)
  • Informed Consent for Liver Transplant Evaluation Process (Spanish)
  • GI Pre-Procedure Orders
  • Physician's Order Form
  • Pre-Op Ambulatory Surgery
  • Imaging Center Requisition

Comprehensive Liver Center at Hartford Hospital

  • Medical Office Building
    85 Seymour Street
    Suite 324
    Hartford, CT 06106
    Get Directions >>
  • Contact Us

  • Find a Hepatology Specialist


Related Links

Liver Transplantation

Organ Donation Options


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